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RxPRC WILL REVIEW HCFA POINT-OF-SALE, DUR PLANS AT FIRST MEETING

Executive Summary

RxPRC WILL REVIEW HCFA POINT-OF-SALE, DUR PLANS AT FIRST MEETING scheduled for Sept. 25-26 at the Hyatt Regency, Capitol Hill in Washington. The Prescription Drug Payment Review Commission (RxPRC) was established by the Catastrophic Coverage Act to make annual reports to Congress on prices, pharmacy charges and utilization of outpatient drugs covered under the act. The commission's first meeting comes approximately nine months after its members were announced by the congressional Office of Technology Assessment ("The Pink Sheet" Jan. 16, p.7). At the session, the commission will hear a presentation on the Health Care Financing Administration's recently issued request for proposals (RFP) for drug claims processors to manage the new catastrophic benefit. In the RFP, HCFA outlines its plan for a point-of-sale system and a drug utilization review (DUR) program. The commission is chaired by Alice Rivlin, PhD, a senior fellow in the Brookings Institute's Economic Studies Program. Rivlin was also the first director of the Congressional Budget Office. The commission will also be updated on the status of the current movement in Congress to repeal at least parts of the catastrophic benefit package in response to persistent complaints from senior citizens regarding the high premiums required by the law. RxPRC Executive Director Stephen Long acknowledged the commission's concern with regard to its future at a Sept. 11 Office of Technology Assessment meeting. However, he noted that the commission is proceeding with its current work schedule on the assumption that "the ]drug[ benefit survives." The commission plans to meet two more times before the end of the year, on Nov. 9-10 and Dec. 4-5, and expects to have two other meetings next spring. The eleven-member group is working toward gathering a support staff of 25. The OTA meeting was held to discuss development of a study on alternative payment methodologies for the drug benefit. Long noted that the duties of the commission, as mandated by the law, include: monitoring the viability of the drug trust fund; reviewing reimbursement rates and prices; assessing the impact of the benefit on beneficiaries; looking at the Administration's oversight role as the point-of-sale system is implemented and reviewing quality of care issues with regard to DUR.
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